Pentagon, Congress argue over new hospital for troops

Updated 10:29 pm, Sunday, June 10, 2012

The Defense Department is closing and relocating the venerable Landstuhl Regional Medical Center in Germany.

The Defense Department is closing and relocating the venerable Landstuhl Regional Medical Center in Germany.

Photo: Michael Probst

Pentagon, Congress argue over new hospital for troops

1 / 1

Back to Gallery

WASHINGTON — As the Pentagon and Congress argue over how to shrink the military to fit smaller federal budgets, no debate over matching money to mission is more heartfelt than the order to shut down the premier overseas hospital for severely wounded troops and replace it with a new one.

The hospital has earned its vaunted reputation during the past decade as it has evacuated, treated and stabilized all U.S. military personnel injured in Afghanistan and Iraq. It treats 500,000 patients a year.

There is no dispute that replacing the hospital, which opened 59 years ago, is a good idea. And building its replacement next to Ramstein Air Base in Germany would reduce transit time for patients. Additional savings would be found by closing Ramstein's existing clinic and combining it with the Landstuhl replacement.

But a debate is simmering over how large a hospital, and with how many emergency and trauma treatment beds, should be built. The underlying question is what kinds of missions the military should be prepared to undertake in the years and decades to come.

The war in Iraq is over. The conflict in Afghanistan is winding down. And the Army is cutting the number of combat brigades in Europe. So the Pentagon and Congress are reluctant to invest in a hospital that is so large that it would be necessary only if there is another full-scale war.

But military commanders point out that on Sept. 10, 2001, the day before the terrorist attacks in the United States, the Landstuhl hospital looked like an aging white elephant — yet during the next 10 years, it became the critical link in a chain of medical care that begins on the battlefield and moves on to long-term treatment in the United States. The commanders want a hospital that is large enough, and flexible enough, to treat casualties from an unexpected crisis in Europe or Africa, the Middle East or the Indian Ocean region.

Congress rejected the Pentagon's initial proposal for a $1.2 billion hospital to be built over seven years; counterproposals from the Senate and House cut the request by up to one-third. A smaller sum just to get the project under way is in the current budget.

Legislators say they remain open-minded about whether the final cost should be higher — but they say they cannot make a final decision because the Pentagon has not provided adequate information and analysis for Congress to vote on a price.

In a blistering critique of the Pentagon's initial plan, the Government Accountability Office, the auditing and investigative arm of Congress, rejected proposals from Dr. Jonathan Woodson, the assistant secretary of defense for health affairs because he had failed to demonstrate how the Pentagon had come up with a $1.2 billion price tag for the hospital.

Pentagon officials told Congress that the replacement hospital “is being sized for peacetime operations, not for contingency operations,” according to the GAO study. But the GAO also said that Defense Department officials told them that the hospital would have the capability to expand to handle the casualties should another war break out.

The GAO study, released last month, found “inconsistencies, gaps and calculation errors in planning documentation” that the Defense Department provided in determining the size for the new hospital. The proposal also did not include the latest round of troop cuts in Europe.

In the Pentagon's official response to Congress, Woodson wrote that he accepted the GAO's criticisms. He stressed that the Defense Department had conducted a reassessment of the $1.2 billion proposal. A new plan — along with “a documented audit trail of how the size, scope and cost of the alternatives” were determined — would be provided to Congress after it was approved by Defense Secretary Leon E. Panetta, he wrote. No timetable was provided.

Military commanders say they have no doubt that Landstuhl's replacement will provide state-of-the-art medical care for wounded troops. But they remain concerned that tight budgets — and an assessment that the nation will not soon be drawn into another war — might result in a hospital that is too small to make good on the military's pledge to provide the finest and fastest medical care to wounded troops anywhere in the world.

One officer expressing caution over potential reductions in the hospital's capacity is Lt. Gen. Mark P. Hertling, who served two tours in Iraq after the 2003 invasion and is now commander of the Army's forces in Europe.

In a letter to Woodson, Hertling wrote that in assessing the medical requirements for the Landstuhl replacement hospital, “there are some who simply see it as linked to the current conflicts or, worse, linked to the size of the force and the families stationed in Europe.”

“As we look to the future, the key issue will be how much we need at this strategic location for unknown operational support to multiple theaters,” Hertling wrote.

“The decisions made with regard to this facility will affect our national security in multiple regions for the next century.”